scholarly journals Four Years of Observation to Evaluate Autonomy and Quality of Life after Implantation of a High-Add Intraocular Lens in Age-Related Macular Degeneration Patients

2020 ◽  
Vol 11 (2) ◽  
pp. 448-456
Author(s):  
Andreas F. Borkenstein ◽  
Eva-Maria Borkenstein

Visual impairment resulting from advanced dry age-related macular degeneration (AMD) limits the ability to perform activities required for independent living and adversely affects quality of life. We aimed to determine changes in these parameters in patients with AMD-related geographic atrophy who underwent magnifying cataract surgery (MAGS) using a foldable, bifocal high-add intraocular lens (IOL). The high-add IOL (LENTIS® MAX LS-313 MF 80, Oculentis) was implanted in the better seeing or dominant eye of eligible patients with clinically significant cataract, best corrected distance visual acuity 1.3–0.5 logMAR (20/400–20/63), best corrected near visual acuity >0.8 logMAR (20/125), and stable advanced dry AMD. Self-reported feasibility of performing routine activities and change in quality of life were the main outcome measures. Eleven of 15 operated patients had complete follow-up to 48 months. There were no significant intraoperative or postoperative complications. AMD converted from dry to wet in 2 patients. All patients reported functional gains in the first 3–6 months after surgery, and 10/11 patients reported improved quality of life. From baseline to 48 months, functional performance remained improved in all patients, and quality of life remained improved in the 9 patients with stable AMD. Best corrected distance visual acuity and uncorrected near visual acuity improved in all cases after surgery. Conclusion: Implantation of the high-add IOL was safe and resulted in durable functional and quality of life benefits. To our knowledge, our report describes the longest prospective follow-up (4 years) of a series of patients undergoing MAGS for rehabilitation of low vision related to advanced AMD. Data are needed from larger cohorts, but our experience supports giving consideration to MAGS in appropriately selected patients with low vision related to advanced dry AMD. We encourage further industry development of this technology and additional clinical research to collect more outcomes data to determine its potential to help patients maintain highly valued autonomy and quality of life.

2020 ◽  
Author(s):  
Wei Bian ◽  
Junli Wan ◽  
Mingqiong Tan ◽  
Jun Su ◽  
Yi Yuan ◽  
...  

Abstract Background: Age-related macular degeneration (AMD) is currently the leading cause of irreversible visual impairment in developed countries and seriously affects the health-related quality of life (HRQoL) of patients. However, the majority of the research in this area employs cross-sectional design; longitudinal research investigating changes in HRQoL and influencing factors is limited. The aim of this study was to use a longitudinal study design to investigate descriptive trends in HRQoL and their predictive factors in Chinese AMD patients receiving treatment with vascular endothelial growth factor inhibitors (anti-VEGF) at baseline and follow-ups.Methods: In a sample of 142 AMD patients from the outpatient clinic of the Southwest Eye Hospital, a tertiary major hospital in the southwest of China, each patient completed a self-administered questionnaire assessing demographics, clinical features, HRQoL, depression, anxiety, coping style, social support, and self-efficacy at baseline and at 1-, 3-, 6-, and 12-month follow-up appointments.Results: The total score of HRQoL fluctuated, with the highest score at the 6-month follow-up and the lowest score at baseline. Multivariable linear regression showed the predictors of HRQoL are best-corrected visual acuity (BCVA), income level, depression, and visual acuity (VA) of the treated eye at baseline; BCVA, income, and depression at the 1-month follow-up; duration, area of residence, gender, VA of the treated eye, BCVA, income, anxiety, social support, self-efficacy, and depression at the 3-month follow-up; gender, BCVA, income, anxiety, social support, self-efficacy, depression, negative coping, and positive coping at the 6-month follow-up; and BCVA, social support, self-efficacy, and depression at the 12-month follow-up.Conclusions: The HRQoL and its predictive factors in Chinese AMD patients receiving anti-VEGF treatment fluctuated over time. It is suggested that medical staff should get more information when planning precise care for improving patients’ HRQoL.


Author(s):  
Daniel Caballe-Fontanet ◽  
Cristina Alvarez-Peregrina ◽  
Neus Busquet-Duran ◽  
Eduard Pedemonte-Sarrias ◽  
Miguel Angel Sanchez-Tena

Background: Age-related macular degeneration (AMD) is a disease with an increasing incidence due to the general aging of the population that decreases the patient’s quality of life. This work aims to study whether selective cut optical filters improve the AMD patient’s quality of life. Methods: Prospective and longitudinal study in 79 patients. Visual acuity, contrast sensitivity, and the line differences in the Colenbrander test were measured. Patients answered The National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25), which measures the quality of life related to vision before and after using cut optical filters. Results: There was an improvement of 5.99 points (3.7–8.3) in NEI VFQ-25 after wearing filters. This improvement was 4.0 points for 450-nm filters and 12.7 points for 511-nm filters. For patients with visual acuity (VA) < 0.25, results of NEI VFQ-25 increased by 10.11 points (1.19–19.02) and for patients with late AMDs, results increased by 5.33 points (1.31–9.35). Conclusions: Selective filters improve the quality of life of patients with AMD. The success rate in the fitting of filters is better for those with VA lower than 0.25 and those with late or advanced AMD.


2020 ◽  
pp. 112067212097262
Author(s):  
Theodoros P Marakis ◽  
Chrysanthi Koutsandrea ◽  
Maria S Poulou

Purpose: To investigate the validity and reliability of the Greek Impact of Vision Impairment Questionnaire (IVI) and to explore the predictors of vision-related quality of life (VRQoL) in individuals with neovascular age-related macular degeneration (nAMD). Methods: About 191 patients completed the IVI and the SF-12 Health Survey, and were assessed on visual exams. A random group of 20 participants completed the IVI twice with a 2 weeks interval, to assess test-retest reliability. About 102 patients completed the IVI 1 year later in a follow-up examination. Rasch analysis was used to evaluate response category functioning, scale precision, unidimensionality, scale targeting and differential item functioning. Stepwise multiple linear regression analyses identified predictors of VRQoL. Results: Test-retest reliability of IVI items was calculated from 0.86 to 0.98. The six response categories were merged into four to figure out disordered thresholds. Rasch analysis concluded in three scales: Mobility and Independence, Reading and Accessing Information, and Emotional Wellbeing. Regarding convergent validity, the IVI scores had significant associations with SF-12 components (ρ = 0.28–0.47) and measurements of visual acuity (ρ = 0.39–0.66). Worse VRQoL at 1 year follow-up was correlated with decline in distance and near VA. Distance VA and the SF-12 components were common predictors for all three subscales. The duration of disease was a significant predictor for the emotional subscale. Conclusion: The Greek IVI was found to assess AMD patients’ perceptions of VRQoL in a valid, reliable and responsive to eyesight manner. VRQoL was mainly established by patients’ distance VA and mental health.


2021 ◽  
pp. bjophthalmol-2020-318269
Author(s):  
Ryan Eyn Kidd Man ◽  
Alfred Tau Liang Gan ◽  
Eva K Fenwick ◽  
Kelvin Yi Chong Teo ◽  
Anna C S Tan ◽  
...  

BackgroundWe examined the associations between the 6-year incidence of age-related macular degeneration (AMD) and vision-related quality of life (VRQoL), and the contribution of presenting visual acuity (VA), in an Asian population.MethodsFundus images from the Singapore Chinese Eye Study, a population-based cohort study (baseline: 2009–2011; follow-up: 2015–2017), were graded using a modified Wisconsin age-related maculopathy grading system. Incident AMD was defined as no baseline AMD in both eyes and early/late AMD in the worse eye at follow-up. Presenting VA was assessed using the logarithm of the minimum angle of resolution chart at 4 m under standard lighting conditions with habitual correction. Multiple linear regression models determined the associations between AMD incidence with changes in the Rasch-transformed scores of the Reading, Mobility and Emotional VRQoL domains of the 32-item Impact of Visual Impairment (IVI-32) questionnaire, adjusted for traditional confounders. The contribution of presenting VA to changes in VRQoL was also estimated.ResultsOf the 2251 participants without AMD at baseline (mean age (SD): 57.7 (9) years, 51.4% women), 101 (4.5%) and 11 (0.5%) developed incident early and late AMD at follow-up, respectively. Incident late AMD was associated with significant 30.3%, 32.5% and 30.9% decrements in Reading, Mobility and Emotional IVI scores, respectively. The contribution of presenting VA ranged between 1.62% and 4.35% of the observed decrements. No significant associations were noted with incident early AMD.ConclusionIncident late AMD had a substantial impact on all aspects of VRQoL, with presenting VA contributing only minimally to this longitudinal relationship.


2017 ◽  
Vol 102 (3) ◽  
pp. 377-382 ◽  
Author(s):  
Eva K Fenwick ◽  
Gemmy Chui Ming Cheung ◽  
Alfred TL Gan ◽  
Gavin Tan ◽  
Shu Yen Lee ◽  
...  

AimTo assess the change in vision-related quality of life (VRQoL) after treatment for neovascular age-related macular degeneration (nAMD) and factors influencing this change in an Asian population.MethodsIn this longitudinal study, 116 patients (mean age±SD=66.5±9.9 years; 59.5% male) who underwent treatment for nAMD were recruited from a tertiary eye centre in Singapore. Best-corrected visual acuity (BCVA) and the Impact of Vision Impairment (IVI) questionnaire were evaluated at baseline and month 12. We defined three categories of BCVA change in the treated eye: BCVA gain ≥2 lines; no change in BCVA; BCVA loss ≥2 lines. The main outcome measures were the Rasch-derived IVI Reading, Mobility, and Emotional Scores. Multivariable linear regression analyses assessed the influence of sociodemographic, clinical and treatment-related factors on change in VRQoL.ResultsFollowing treatment, mean treated-eye BCVA improved by almost 2 lines (−0.22±0.40 logMAR, p<0.001) and 43% (n=50) patients reported a gain in BCVA of ≥2 lines. Mean±SD scores for Reading, Mobility and Emotional demonstrated positive changes of 0.43±1.73, 0.45±1.54 and 0.66±1.6, respectively (p<0.001 for all). In multivariable models, a ≥2 line improvement in BCVA was independently associated with a 47% (β=0.20; CI 0.01 to 0.39) increase in Reading Scores, but was not independently associated with Mobility or Emotional Scores.ConclusionNearly half of patients undergoing treatment for nAMD reported a 2-line improvement in vision which was, in turn, associated with substantial positive increases in Reading Scores. Improvements in Mobility and Emotional Scores appear to be driven by factors other than visual acuity.


2020 ◽  
pp. 026461962097370
Author(s):  
Marios Papalamprou ◽  
Constantine D Georgakopoulos ◽  
Nikolaos Pharmakakis

Purpose: The purpose of this study was to investigate the impact on the quality of life of patients with age-related macular degeneration (AMD) in relation to common mental disorders, namely anxiety and depression, and determine specific factors (e.g., thoughts/feelings, sociodemographic characteristics) that may be used to refer such patients to psychiatrists. Materials–Methods: To classify the patients into different categories, regarding the development of the mental disorders under consideration, the “Hospital Anxiety and Depression Scale” (HADS) has been utilized. The main statistical methodologies applied are classification and regression trees (CART) techniques and logistic regression. For the purposes of the aforementioned statistical analysis, the R software package has been used. Results: Both depression and anxiety scores varied considerably across visual acuity (VA) severity. Patients with severe visual acuity problems tend to have also higher HADS scores. Women were more likely to be affected by depression; sociodemographic factors did not have any significant effect. According to the performed CART analysis, responses to two HADS items (namely, “I can enjoy a good book or radio or television program” and “I have lost interest in my appearance”) identified the vast majority of severely to moderately depressed patients. Furthermore, the level of VA severity was found as a main driver for diagnosing an AMD patient with depression. Conclusions: VA impairment (or decline) severity level was found to be the main factor associated with depression in patients with AMD. Moreover, specific thoughts/feelings present in patients with AMD have been found as significant regarding the level of their mental disorders under consideration and could be asked by the ophthalmologist to refer (or not) them to psychiatrists.


2014 ◽  
Vol 7 (1) ◽  
pp. 47-57
Author(s):  
Igor Anatolevich Loskutov

Ranibizumab treatment leads to rapid visual acuity improvement, which may be observed in as little as a week after the first injection, and may lead to quality of life improvement as estimated by VFQ-25 questionnaire. The retinal thickness progressively decreased in the course of treatment, what along with the lesion size reduction results in visual function improvement. The quality of life assessment using the VFQ-25 questionnaire revealed an improvement in all subscale positions during first months of monitoring, when visual acuity increase helps the patient perform routine daily activities. The longer Lucentis is needed and used, the trend is less optimistic, and patients acknowledge a quality of life decrease. Total VFQ-25 score has well-defined rises and descents, favoring treatment efficacy as well as the necessity of additional injections according to clinical need.


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